What about side effects?

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Guide to avoiding and managing side effectswww.i-base.info/guides/side

Everyone worries about side effects.

But within a few weeks, most people find that taking HIV treatment is easier than they thought. It usually becomes an ordinary and manageable part of daily life.

• Most side effects are usually mild.
• They can often be reduced with other medication that is easy to use or by switching to other drugs.
• There is only a small risk of serious side effects, and these should be picked up by careful routine monitoring.

Most common side effects

Nausea (feeling sick), diarrhoea and tiredness are the most common general side effects.

• These often become easier after the first few weeks.
• Very rarely, nausea and tiredness can be very serious. This is why you should tell your doctor of any problems.
• If anti-nausea or diarrhoea medications do not help, ask your clinic for stronger or more effective drugs.

One of the most used drugs (efavirenz, Sustiva) can affect sleep patterns and mood changes.

• You need information about this before starting treatment.
• These side effects are usually strongest when you first start treatment. They usually reduce in most people over the first few weeks.
• If the side effects continue you can use another drug.

Lipodystrophy and metabolic changes

Lipodystrophy refers to changes in fat cells and the distribution of body fat. It also refers to changes in blood fat and blood sugar levels (metabolic changes).

• We do not know what causes these changes, which usually, but not always, develop slowly over many months.
• This is one of the biggest worries for people who are about to start treatment.
• Not everyone gets lipodystrophy and new drugs used in first-line therapy do not cause fat loss. The greater awareness of lipodystrophy also means that you will be monitored carefully.
• If you have any difficulties make sure your doctor takes them seriously and does something about it.

Fat loss
Fat loss (from arms, legs, face and buttocks) has only been linked to two drugs – d4T and AZT – which are no longer recommended for first-line therapy.

Fat accumulation
Fat accumulation, to the stomach or breasts and/or across the shoulders, has been linked to combinations that include protease inhibitors and NNRTIs. Careful body measurements by a dietician, by DEXA scan, or photographs can monitor changes. You can change treatment if you get early symptoms. Early symptoms may reverse if you switch to different HIV drugs. Exercise and dietary changes can also help.

Changes to blood fat and blood sugar levels
Most drugs can change fat (cholesterol and triglycerides) and sugar (glucose) levels, which are monitored by routine blood and/ or urine tests. These are best performed when you are fasted (ie before you eat or drink anyting that day).

Other side effects

More serious side effects can occur with most combinations, although more rarely. They are also linked to specific drugs.

It is important to be aware of these for all the drugs in your combination, before you start treatment.

Guide to avoiding and managing side effects

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This is the web edition of the i-Base guide Introduction to combination therapy. This guide is available in UK clinics. You can order free printed copies or download a PDF version (513 Kb). Translations. Authors and credits. Glossary. Full section index.

Decisions relating to your treatment should always be taken in consultation with your doctor. Information in this guide is intended to support those discussions.